Bowel Obstructions – Pathophysiology, Nursing Care Plan, and Podcast

Bowel Obstruction

Bowel Obstruction

Bowel obstruction means an intestinal obstruction. On the other hand, we can say that in a bowel obstruction, there is a blockage that prevents the necessary body nutrients and waste products to flow correctly through the gastrointestinal tract. The blockage can happen in the upper portion or the lower portion of the intestine. A tumor or even swelling in the intestine can cause blockages.

** Note an Ileus is a blockage caused by failure or decreased peristalsis rather than a mechanical obstruction.

Causes of Bowel obstruction:

Adhesions: Adhesion is a particular area of  fibrous connective tissue. This can be thought of like a scar or scar tissue. Adhesions can develop because of injury inside or outside of the intestine or even the pelvic area. Usually anything that disturbs the tissue in the intestinal tract or almost anywhere in the body can cause adhesions.

There are many different causes of bowel obstructions:

  • Paralytic ileus
  • Use of certain medications (narcotics)
  • Foreign Body
  • Hernia
  • Colorectal cancer
  • Volvulus: twisting of the intestine
  • Diverticular disease or crohn’s disease.
  • Difficulties in passing stools or impacted stools these are severe constipations.
  • Intussusception: telescoping of part of intestine
  • Congenital malformation of the bowel
  • Swelling/ inflammation
  • Tumors: A cancerous tumor can develop into a bowel obstruction, usually the tumor will cause a smaller obstruction in the beginning. As time passes, tumors can grow and eventually cause larger obstructions.

 

Signs and symptoms of bowel obstruction:

  • Vomiting and nausea.
  • A cramping abdominal pain that comes like a wave frequently for five to ten minutes.
  • A bloated belly.
  • Having trouble  passing gas.
  • Burping
  • An abdominal tenderness
  • Rapid pulse and increased respiration’s (breathing) at the time of abdominal cramping.
  • Diarrhea: liquid stool leaking from the area of partial obstruction.
  • A colon tumor is another cause of having a large bowel obstruction.
  • Lower abdominal pain; which can be mild or severe. The pain will depend on causes of bowel obstruction.

Bowel Obstruction

Diagnostics:

Labs: due to possible electrolyte imbalances. Specifically Chloride, Potassium, and Sodium.

CT of the abdomen

X-ray of the abdomen

Barium enema

Upper GI and Small Bowel Series

 Treatments

Treatment is focused on relieving the obstruction and the cause of the obstruction.

NPO

IV Fluids

NG tube to low intermittent suction. This is for intestinal descompression.

Pain medications as ordered by MD (Note some pain medication can cause constipation)

 

Surgical Treatments

A treatment called sigmoidoscopy or colonoscopy. The process starts by inserting a thin, flexible tube that contains a small camera and light attached to one end. The tube is inserted into the rectum and passes through the bowel. A flatus tube (a long rubber tube) is also inserted that decompress the bowel.

Laparoscopy: This surgery is also known as a keyhole surgery. In a laparoscopy surgery, the process starts by inserting a small tube with a light and camera at the end. Laparoscopy may be a helpful surgery for treating a small bowel obstruction or removing adhesions.

Endoscopic stenting: Endoscopic stenting is treatment process, where a self-expanding stent or pipe is inserted. The pipe helps to keep the passageway open. This process is considered when the patient is  elderly or in palliative care of cancer patients.

 

Complications:

It is important to note that if the obstruction stops or impedes blood supply to the intestines, infection or gangrene (death of tissue may result).

Other complications can include:

  • Dehydration
  • Perforation of the intestinal wall
  • Infection
  • Jaundice
  • Electrolyte imbalances

 

Podcast

 

 

 

Nursing Care Plan

Nursing Diagnosis

1. Acute pain related to distention and rigidity as evidenced by patient rates pain at 8/10 on pain scale and states abdominal cramping and tenderness in abdomen.

Desired outcomes:

Patient will report a decrease in pain from 8 to 0 on the pain scale by discharge.

InterventionsRationals
InterventionsRationals
Assess level of pain using appropriate pain scale. Assess pain 30 minutes before and after pain medication is given.Using an appropriate age pain rating scale will help the healthcare providers monitor the level of pain and adjust pain medications as needed.
Administer pain medications as prescribed and indicated.Analgesics are helpful in relieving pain and helping in the recovery process.
Have patient maintain limited bedrest and activityThis will help to minimize pancreatic secretions and pain.
Incorporate nonpharmacologic measures to assist with control of pain.Ideally, the use of comfort measures will distract the patient from pain and may increase the effectiveness of pharmacological measures.

2. Risk for Infection related to development of inflammatory process or worsening bowel obstruction.

Desired outcomes:

By discharge, the patient will remain free signs and symptoms of infection.

InterventionsRationals
InterventionsRationals
Assess vital signs including temperature every 4 hours and as needed. Report any abnormal findings to the healthcare provider.Fever is often one of the first signs of infection.
Assess mental status and level of consciousnesses every 4-6 hours.Mental status changes, confusion, or any deterioration from baseline can signify infection.
Report and note any abnormal laboratory values (i.e. elevated WBC count) to the healthcare provider.Certain abnormal laboratory results could be an indicator of infection.

Other possible nursing diagnosis:

Risk for imbalanced fluid volume

Impaired gas exchange

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN-BC, BSN, PHN, CMSRN Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process. She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

One comment

  • Dapo

    Anna C., Thank you and God bless you. This was simple and straight to the point. Very helpful. Continue the good work.

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